Department of Radiation Oncology, Washington University School of Medicine, Saint Louis, MO 63108, USA.
Breast Cancer Res Treat. 2013 Feb;138(1):127-35. doi: 10.1007/s10549-013-2412-6. Epub 2013 Jan 18.
The purpose of this study was to analyze the cost-efficacy of multiple accelerated partial-breast irradiation (APBI) techniques compared with whole breast irradiation (WBI) delivered utilizing 3-dimensional conformal radiotherapy (3D-CRT) and intensity-modulated radiation therapy (IMRT). A previously reported matched-pair analysis consisting of 199 patients receiving WBI and 199 patients receiving interstitial APBI formed the basis of this analysis. Cost analyses included a cost minimization analysis, incremental cost- effectiveness ratio (ICER) analysis, and cost per quality adjusted life year (QALY) analysis. Per 1,000 patients treated, the cost savings with the utilization of APBI compared to WBI IMRT is $14.9 million, $10.9 million, $8.8 million, $5.0 million, and $9.7 million for APBI 3D-CRT, APBI IMRT, APBI single-lumen (SL), APBI multi-lumen (ML), and APBI interstitial, respectively. Per 1,000 patients treated, the cost savings with the utilization of APBI compared to WBI 3D-CRT is $6.0 million, $2.0 million, and $0.7 million for APBI 3D-CRT, APBI IMRT, and APBI interstitial, respectively. The cost per QALY for APBI SL, APBI ML, and APBI interstitial compared with APBI 3D-CRT are $12,273, $66,032, and $546, respectively. When incorporating non-medical costs and cost of recurrences the cost per QALY was $54,698 and $49,009 for APBI ML compared with APBI 3D-CRT. When compared to WBI IMRT, all APBI techniques are cost-effective based on cost minimization, ICER, and QALY analyses. When compared to WBI 3D-CRT, external beam APBI techniques represent a more cost-effective approach based on cost minimization with brachytherapy representing a cost-effective approach based on cost per QALY.
本研究旨在分析与接受三维适形放疗（3D-CRT）和调强放疗（IMRT）的全乳放疗（WBI）相比，多种加速部分乳房照射（APBI）技术的成本效益。该分析以之前报告的一项匹配对分析为基础，该分析包括 199 例接受 WBI 治疗的患者和 199 例接受间质 APBI 治疗的患者。成本分析包括成本最小化分析、增量成本效益比（ICER）分析和每质量调整生命年（QALY）成本分析。与 WBI-IMRT 相比，每 1000 例接受治疗的患者中，APBI-3D-CRT、APBI-IMRT、APBI 单腔（SL）、APBI 多腔（ML）和 APBI 间质治疗的成本节约分别为 1490 万美元、1090 万美元、880 万美元、500 万美元和 970 万美元。与 WBI-3D-CRT 相比，每 1000 例接受治疗的患者中，APBI-3D-CRT、APBI-IMRT 和 APBI 间质治疗的成本节约分别为 600 万美元、200 万美元和 700 万美元。与 APBI-3D-CRT 相比，APBI-SL、APBI-ML 和 APBI 间质治疗的每 QALY 成本分别为 12273 美元、66032 美元和 546 美元。当纳入非医疗成本和复发成本时，APBI-ML 与 APBI-3D-CRT 相比，每 QALY 的成本为 54698 美元和 49009 美元。与 WBI-IMRT 相比，所有 APBI 技术基于成本最小化、ICER 和 QALY 分析均具有成本效益。与 WBI-3D-CRT 相比，外照射 APBI 技术基于成本最小化更具成本效益，而近距离放疗基于每 QALY 的成本更具成本效益。
